Provider Demographics
NPI:1447240478
Name:EDELMAN, REED S (OD)
Entity Type:Individual
Prefix:DR
First Name:REED
Middle Name:S
Last Name:EDELMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 BERACASA WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3448
Mailing Address - Country:US
Mailing Address - Phone:561-750-7774
Mailing Address - Fax:561-392-3200
Practice Address - Street 1:7124 BERACASA WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3448
Practice Address - Country:US
Practice Address - Phone:561-750-7774
Practice Address - Fax:561-392-3200
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOB426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19016Medicare PIN
FLT84172Medicare UPIN